DSM-5 Diagnostic Criteria for Opioid Use Disorder

Opioid analgesics (termed opioids in this report) are a class of drugs commonly prescribed to treat moderate to severe pain. Opioids include drugs available by prescription such as oxycodone, hydrocodone, codeine, morphine, and fentanyl. Opioids also include illicit substances such as heroin and fentanyl. Although often prescribed to control pain, opioids may also produce feelings of euphoria and sedation which may lead to misuse of opioids resulting in opioid use disorder.

DSM-5 Diagnostic Criteria for Opioid Use Disorder

A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. Opioids are often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
  3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
  4. Craving, or a strong desire or urge to use opioids.
  5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
  7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
  8. Recurrent opioid use in situations in which it is physically hazardous.
  9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. *Tolerance, as defined by either of the following:
    1. A need for markedly increased amounts of opioids to achieve intoxication or desired effect.
    2. A markedly diminished effect with continued use of the same amount of an opioid.
  11. *Withdrawal, as manifested by either of the following:
    1. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdrawal).
    2. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

* Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.

Specify if:

  • In early remission: After full criteria for opioid use disorder were previously met, none of the criteria for opioid use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion 4A, “Craving, or a strong desire or urge to use opioids,” may be met).
  • In sustained remission: After full criteria for opioid use disorder were previously met, none of the criteria for opioid use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion 4A, “Craving, or a strong desire or urge to use opioids,” may be met).

Specify if:

  • On maintenance therapy: This additional specifier is used if the individual is taking a prescribed antagonist medication such as methadone or buprenorphine and none of the criteria for opioid use disorder have been met for that class of medication (except tolerance to or withdrawal from the agonist). This category also applies to those individuals being maintained on a partial agonist, an agonist/antagonist, or a full antagonist such as oral naltrexone or depot naltrexone.
  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to opioids is restricted.

Specify current severity:

  • Mild: Presence of 2–3 symptoms.
  • Moderate: Presence of 4–5 symptoms.
  • Severe: Presence of 6 or more symptoms.

 

References:

  1. Boscarino JA, Hoffman SN, Han JJ. Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates. Subst Abuse Rehabil. 2015 Aug 19;6:83-91. [Medline]
  2. Zoorob R, Kowalchuk A, Mejia de Grubb M. Buprenorphine Therapy for Opioid Use Disorder. Am Fam Physician. 2018;97(5):313-320. [Medline]

Created 14 Jul, 2020.